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Company Name*

Street Address

City

State

Full Name

Title

Email Address*

Phone Number*

Fax

Date Quote Required

Example: December 15, 2012

Project Completion Date

Example: December 15, 2012

Project Reference

Estimated Project Budget

Job Site Elevation

(Feet above sea level)

Application

(Check all that apply)

General Cleanup
Production
Dust Collection / Source Capture
Product Reclaim
Batching Processing / Pnematic Conveying
Other

If other, please specify.

Name / Description of Material

Can Sample Be Provided?

Yes
No

Bulk Weight of Material

(Pounds per Cubic Foot)

% Moisture by Volume

Minimum Particle Size

Maximum Particle Size

Particle Temperature (F)

Room Temperature (F)

Pick-Up Velocity

(Estimated Feet Per Minute)

Angle of Repose

Material Characteristic

(Check all that apply)

Hydroscopic
Sticky
Abrasive
Free-Flowing
Corrosive / Acidic
Hazardous / Toxic
Compatible
Explosive

Type of Surface to be Cleaned

Floor
Machinery
Other

If other, please specify.

Equipment Frame Requirements

(Check all that apply)

Portable
Stationary
Special Mounting
Other

If other, please specify.

List any Dimensional Limitations:

Height

Length

Width

Weight

Required Material Storage Capacity

Stored Material Will Be Disposed of:

If other, please specify.

Discharge Method

If other, please specify.

System Duty Cycle

Continuously
Intermittently

Filtration Required % at Microns

Style of Filter Preferred

Pulse Clean Cartridge
Manual Filter Shaker
Polyester Bag
PTFE Coating
HEPA
Other

If other, please specify.

Number of Conveying Point to Operate Simultaneously

(Number of Users)

Hose Feet in Length

(Check all that apply)

25 Feet
50 Feet
Other

If other, please specify.

Is 90 PSIG Compressed Air Available?

Yes
No

Explosion Venting Required?

Yes
No

Level Full Sensor Required?

Yes
No

Motor Starter Required?

Yes
No

Voltage Requirements

110
230
460
575

Frequency (Hz)

60 Hz
50 Hz

Electrical Phase

0
1
3

Panel Enclosure

NEMA 4
NEMA 7
NEMA 9

General Comments

Name

This field is for validation purposes and should be left unchanged.

List any Dimensional Limitations:

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